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A Lesson for Infection Prevention from a London Cholera Outbreak

Aug 04, 2008

Dr. John Snow is credited with taking bold action when he sensed that contaminated water from the public pump on Broad Street was the cause of deadly cholera during the 1854 outbreak in London. Here is what he wrote of his legendary action on Sept. 7, 1854: “I had an interview with the Board of Guardians of St. James Parish, on the evening of Thursday, 7th September, and represented the above circumstances to them. In consequence of what I said, the handle of the pump was removed on the following day.”

So who was the parish Board of Guardians and why did they respond as they did to Snow’s recommendation? In England, the parish is the local government. The Saint James Parish encompassed the region serviced by the Broad Street pump. The Board of Guardians was elected by local citizens, but only those who owned property, thereby excluding many ordinary people. The voters were usually small tradesmen or shopkeepers who were concerned with public safety and order. The Board of Guardians was responsible, among other concerns, for maintaining public health, but relied on the advice of medical practitioners such as Snow.

There were several views of what happened on Sep. 7, 1854, when Snow spoke to the Board of Guardians at the Vestry Hall near his home and the impact thereafter on the Broad Street outbreak.

Snow’s good friend, Dr. Benjamin Richardson, wrote years later in 1858 of the Sept. 7th meeting: “When the Vestry (the term used for a committee of members elected to administer the temporal affairs of a parish) men were in solemn deliberation they were called to consider a new suggestion. A stranger had asked in a modest speech for a brief hearing. Snow, the stranger, was admitted, and in a few words explained his view of the ‘head and front of the offending.’ He had fixed his attention on the Broad Street pump as the source and center of the calamity. He advised the removal of the pump handle as the grand prescription. The Vestry was incredulous but had the good sense to carry out the advice. The pump handle was removed and the plague was stayed. There arose, hereupon, much discussion among the learned... but it matters little for the plague was stayed.”

In 1866, 12 years after the event, Dr. Edwin Lankester wrote further of the pump handle incident. He was a member of a local group that looked into the causes of the Broad Street outbreak, and was later to become the first medical officer of health for the St. James district (the area where the outbreak occurred.) Lankester noted, “The Board of Guardians met to consult as to what ought to be done. Of that meeting, the late Dr. Snow demanded an audience. He was admitted and gave it as his opinion that the pump in Broad Street, and that pump alone, was the cause of all the pestilence. He was not believed — not a member of his own profession, not an individual in the parish believed that Snow was right. But the pump was closed nevertheless and the plague was stayed.”

I love this story. A plague was stayed. Countless lives were spared from a cholera death. But all the intelligent, learned experts refused to believe Snow. The skeptics said: “The plague was on the decline anyway.” “The weather has changed.” “What kind of microscope did he use?” “He says he saw living creatures, did anyone else see them?” There were all sorts of reasons why Snow was not to be believed. Even the evidence — the disease stopped after the pump handle was removed — was not truly attributed to his work, as it was “just a coincidence.”

Every time I proffer a new idea and I am the recipient of similar statements, I remind myself of Snow. Currently, I am looking at silver-coated ice scoops. The super-intelligent people in the infection control profession have had much to say about this — feces and urine have been in ice forever — no one dies from it — how do you know it works, it doesn’t make sense to me, unless an unbiased microbiologist from another facility does the microbiology review, it is not trusted data, etc. I could go on and on.

All I did was test a regular ice scoop against a silver-coated ice scoop, and I found no growth. Sure, the ice scooped is more than likely “contaminated” as an aggressive little seventh grader discovered in her 2004 science experiment that sent a shock wave throughout the fast food industry. But the way I see it, why add whatever is on the hands of the ice scoopers user to the mix. Cholera may not be a concern, but I can think of a lot of viruses, bacteria and fungi that very well may be. And if the silver coating safely prevents the establishment of bacteria supporting biofilms, at a minimum cost, why not?

Deb Paul-Cheadle, RN, CIC, works in infection control for Spectrum Health in Grand Rapids, Mich.